Credit: The Associated Press

FILE-In this March 8, 2017 file photo, Maine Gov. Paul LePage speaks at a town hall meeting in Yarmouth, Maine. On Nov. 7, voters in Maine will decide whether to join 31 other states and expand Medicaid under former President Barack Obama’s Affordable Care Act. LePage is steadfastly against against a referendum to expand Medicaid, which he calls big-government welfare. (AP Photo/Robert F. Bukaty, File)

PORTLAND, Maine — Residents in this rural state grappling with a heroin epidemic and an aging population voted Tuesday to deliver a rebuke to Republican Gov. Paul LePage and join 31 other states that have expanded Medicaid under former President Barack Obama's health care law.

The referendum represents the first time since the law took effect that the question of expansion had been put in front of U.S. voters.

Some 11 million people in the country have gotten coverage through the expansion of Medicaid, a health insurance program for low income people.